On pregnancy among pill acceptors in rural Bangladesh.

In a study comparing the use-effectiveness of 2 kinds of oral contraceptives (OCs)--1 regular dose and 1 low-dose--in a rural area of Bangladesh, pregnancy and amenorrhea or suspected pregnancy were the 2 main reasons for discontinuation. The continuation rate at 12 months was approximately 80%. This paper reports the findings of a follow-up study. The initial study was conducted in rural Manikganj. 6 female workers were used to motivate and distribute OCs among acceptors. 645 acceptors were included in the study and were followed monthly by home visits. After 12 months, 129 acceptors had discontinued, including 62 for pregnancy or amenorrhea. These 62 acceptors were visited and interviewed using a special questionnaire designed to determine as accurately as possible the reason for the pregnancy or suspected pregnancy. 9 of the 62 cases were pregnant before starting the OC. Of the remaining 53, 27 cited pregnancy and 26 gave amenorrhea as the reason for discontinuation. The validation study showed that only 14 of the reported 27 were actually pregnant, 7 of the 26 with amenorrhea. Over 1/2 of the 62 women who discontinued OCs for pregnancy or suspected pregnancy had irregular menses. Temporary discontinuation of the OC appeared to be the reason for the 21 verified pregnancies. There were no significant differences in the socioedemographic characteristics of all acceptors and the pregnant women. A simple pregnancy test and menstrual regulation services would be useful for community based programs using OCs. Visits to the homes of relatives were apparently responsible for 50% of the pregnancies. Acceptors should be encouraged to always take their OCs with them.